Palliative Care in Pediatric Phase I Oncology Trials: A Scoping Review

Clinical trials, particularly Phase I trials that test drug safety and feasibility, are imperative to advance outcomes for children with cancer. These trials, however, pose risks for increased symptom burden and suffering. Early integration of palliative care (PC) during Phase I trial enrollment offers a potential reduction in suffering and improvement in quality of life. Following PRISMA guidelines, we systematically reviewed the literature to identify original research articles involving pediatric and young adult patients (0-25 years) enrolled on Phase I trials that reported on specialty PC involvement. Of the nine articles that met the inclusion criteria, all reported quantitative retrospective data, and two presented a rationale for PC consultation. Metrics related to end-of-life care, hospice discussion or enrollment, and location of death were reported in 89% (n = 8), 78% (n = 7), and 56% (n = 5) of articles, respectively. PC integration was associated with earlier hospice enrollment, increased home and hospice deaths, decreased hospitalizations and intensive care unit utilization, improved care coordination, and better symptom management. Given the potential benefits associated with PC integration, further research should examine patient, caregiver, and clinician attitudes and potential strategies to improve access to PC for patients enrolling in Phase I pediatric cancer trials.